In this paper, we present the mathematical model for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak of SARS-CoV-2 has led to 2,192,469 confirmed cases as of April 17, 2020 and total deaths are 147,360 in 210 different countries, area or territories. The basic reproductive number is formulated using next generation approach. The sensitivity analysis of reproductive number and local stability analysis of mathematical model are discussed. Also, we present numerical approximations for the disease free and endemic equilibrium points for infection of SARS-CoV-2. Also, we propose an efficient SKAZI scheme. Lastly, we present numerical experimentation of SKAZI scheme. The disease free and endemic equilibrium points are graphical reveal for stability and instability of mathematical model.

Utilizing the model of novel coronavirus given by Chen {\it et al.} [A mathematical model for simulating the phase-based transmissibility of a novel coronavirus, Infectious Diseases of Poverty, (2020) 9:24], we intend to generalize the model to fractional order derivative in Atangana-Baleanu sense and to show the existence of solution for the fractional model using Schaefer’s fixed point theorem and for the uniqueness of solution we make use of Banach fixed point theorem. By using Shehu transform and Picard successive iterative procedure, we explore the iterative solutions and its stability for the considered fractional model.

As the pandemic of Coronavirus Disease 2019 (COVID-19) rages throughout the world, accurate modeling of the dynamics thereof is essential. However, since the availability and quality of data varies dramatically from region to region, accurate modeling directly from a global perspective is difficult, if not altogether impossible. Nevertheless, via local data collected by certain regions, it is possible to develop accurate local prediction tools, which may be coupled to develop global models. In this study, we analyze the dynamics of local outbreaks of COVID-19 via a coupled system of ordinary differential equations (ODEs). Utilizing the large amount of data available from the ebbing outbreak in Hubei, China as a testbed, we estimate the basic reproductive number, R0 of COVID-19 and predict the total cases, total deaths, and other features of the Hubei outbreak with a high level of accuracy. Through numerical experiments, we observe the effects of quarantine, social distancing, and COVID-19 testing on the dynamics of the outbreak. Using knowledge gleaned from the Hubei outbreak, we apply our model to analyze the dynamics of outbreak in Turkey. We provide forecasts for the peak of the outbreak and the total number of cases/deaths in Turkey, for varying levels of social distancing, quarantine, and COVID-19 testing.

The coronavirus disease 2019 (COVID-19) is an infectious disease which has rapidly evolved into a pandemic. Though it has affected all disciplines of medical sciences but it has some serious implications pertaining to cardiovascular sciences which have presented unique challenges in front of cardiac surgeons in particular. To flatten the curve of this pandemic, routine cardiac surgeries are being deferred indefinitely resulting in the pool of sick cardiac patients rising day by day. A different perspective is presented on this global catastrophe from the viewpoint of a cardiac surgeon.

Background Telehealth post-operative visits are an attractive strategy to minimize exposure, especially during the SARS-CoV-2 (COVID-19) pandemic. The use of a surgical drain often prevents this minimal-exposure approach in that patients return to the outpatient clinic for drain removal. Methods and Results Following unilateral neck dissection, the customary closed-suction drain was replaced with a self-removing, passive drain dressing to facilitate same-day discharge and telehealth post-operative follow-up. The patient removed the dressing and drain at home during a telehealth visit on post-operative day four and she healed favorably without signs of infection or seroma. Conclusions When thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and healthcare staff.

Brett A. Miles DDS MD1, Bradley Schiff MD2, Ian Ganly MD MS PhD3, Thomas Ow MD MS2, Erik Cohen MD5, Eric Genden MD MPH1, Bruce Culliney MD1, Bhoomi Mehrotra MD6, Steven Savona MD6, Richard J. Wong MD3, Missak Haigentz MD5, Salvatore Caruana MD7, Babak Givi MD8, Kepal Patel MD8, Kenneth Hu MD81Icahn School of Medicine at Mount Sinai, New York, NY2Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY3Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York,4Cancer Institute at St. Francis Hospital, New York, NY5Morristown Medical Center, Leonard B. Kahn Head and Neck Cancer Institute, Morristown, NJ6Northwell Cancer Institute, Monter Cancer Center, Lake Success, NY7Columbia University, New York, NY8NYU Langone Health, New York, NY

Background. The firsts European case series are detecting a very high frequency of chemosensitive disorders in COVID-19 patients, ranging between 19.4% and 88%.Methods. Olfactory and gustatory function was objectively tested in 72 COVID-19 patients treated at University Hospital of Sassari.Results Overall, 73.6% of the patients reported having or having had chemosensitive disorders. Olfactory assessment showed variable degree hyposmia in 60 cases and anosmia in 2 patients. Gustatory assessment revealed hypogeusia in 33 cases and complete ageusia in 1 patient. Statistically significant differences in chemosensitive recovery were detected based on age and distance from the onset of clinical manifestations.Conclusion. Olfactory and gustatory dysfunctions represent common clinical findings in COVID-19 patients. Otolaryngologists and head-neck surgeons must by now keep this diagnostic option in mind when evaluating cases of ageusia and nonspecific anosmia that arose suddenly and are not associated with rhinitis symptoms

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to both the providers, patients, and families.  

Health crises have become a popular topic of discussion. In the wave of the ongoing pandemic, experts have suggested the role of vaping and other tobacco product use exemplifying the vulnerability of the population to contract the COVID-19. We discuss some of the events that led up to these conclusions and also offer a unique insight into another form of tobacco use that is potentially propagating its spread especially in the South Asian region – chewed tobacco. Both of these have been a perennial issue that head and neck cancer surgeons have been dealing with. Governments and Head and Neck cancer care providers now have an opportunity to deal with a common enemy in the midst of this pandemic.

Background: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the  2019 coronavirus disease (COVID-19) pandemic. Methods: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. Results: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment  toxicities from radiation or chemoradiation therapy significantly increase these risks.  Conclusion: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population.  Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.  

Coronavirus disease 2019 (COVID-19) has been declared a pandemic of 2020 by World Health Organization (WHO). Due to its novelty there is very little knowledge available about it, and thus there is a great need of collection of data related to COVID-19, from all around the world. Hence, we have conducted this study, collecting daily data on COVID-19 from National Institute of Health (NIH) Pakistan and WHO, to map the epidemiology of COVID-19 outbreak, forecast its trajectory from 4th April till 30th April, and review the preventive measures taken by government of Pakistan. The data was collected from NIH-Pakistan and WHO official released reports, analysis was done using SPSS version 23 and forecasting was made using time series modeler / expert modeler. The purpose of this study is to draw the attention of international as well as national governing bodies towards the rapidly rising number of COVID-19 cases in Pakistan, and the urgency to evaluate the efficacy of currently implemented strategy against COVID-19. According to this study, the spread of COVID-19 is slower than predicted, but there is an alarming increase in growth rate now, and the predicted COVID-19 cases by the end of April can go up to around 8,000 or higher. Hence, it is crucial for the governing bodies to re-evaluate the current situation and implemented strategy. Discussions should be conducted by the administrators and researchers for any change in the strategy if required, before the situation further aggravates.

The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our healthcare system by the Coronavirus Disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.

Background: COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of healthcare personnel. Methods: The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging Head and Neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular. Recommendations: Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred. Conclusion: These guidelines are intended to help clinicians caring for HNC patients appropriately allocate resources during a healthcare crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.

Kimberley L Kiong MBBS 1 , Theresa Guo MD 1 , Christopher MKL Yao MD 1 , Neil D Gross MD 1 , Matthew M Hanasono MD 2 , Renata Ferrarotto, MD 3 , David I Rosenthal MD 4 , Jeffrey N Myers MD 1 , Ehab Y Hanna MD1, Stephen Y Lai MD 1 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States 2 Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States 3Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. 4Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States Corresponding author: Stephen Y Lai, MD PhD Professor Patient Safety Quality Officer The University of Texas MD Anderson Cancer Center Department of Head and Neck Surgery Division of Surgery 1515 Holcombe Blvd, Unit 1445 Houston, TX 77030  sylai@mdanderson.org  This work did not receive any grant support and has not been presented at any meeting Running title: Changing Head & Neck surgical practice during COVID-19 Keywords : Otolaryngology, Oncology, SARS-CoV2 Abstract: Background: The COVID-19 pandemic has changed healthcare, challenged by resource constraints and fears of transmission. We report the surgical practice pattern changes in a Head and Neck Surgery department of a tertiary cancer care center and discuss the issues surrounding multidisciplinary care during the pandemic. Methods: We report data regarding outpatient visits, multidisciplinary treatment planning conference, surgical caseload, and modifications of oncologic therapy during this pandemic and compared this data to the same interval last year. Results: We found a 46.7% decrease in outpatient visits and a 46.8% decrease in surgical caseload, compared to 2019. We discuss the factors involved in the decision-making process and perioperative considerations. Conclusions: Surgical practice patterns in head and neck oncologic surgery will continue to change with the evolving pandemic. Despite constraints, we strive to prioritize and balance the oncologic and safety needs of patients with head and neck cancer in the face of COVID-19. IntroductionThe rapid spread of the novel coronavirus 2019 (COVID-19) has disrupted healthcare systems globally. Some of the biggest challenges include shortage of hospital beds, healthcare workers and personal protective equipment (PPE). Given these constraints, there has been a simultaneous push for a reduction in elective clinical practice, to further reduce transmission and conserve resources 1.Cancer care is generally not considered elective and decision making about when to initiate or delay treatment during the pandemic has raised complex ethical and resource utilization issues. Yet amidst the pandemic, patients continue to develop and seek treatment for cancer. Head and neck cancers (HNC) can challenge essential functions such as eating, speaking and breathing. Tumor doubling time ranges between 15 to 99 days 2,3 and delaying treatment decreases survival and contributes to adverse outcomes 4,5. As such, there are recommendations for prompt initiation of treatment of HNC after diagnosis and to reduce the total treatment package time6,7. In an effort to limit the potential adverse effects of delaying cancer treatment during this pandemic, an increasing number of oncology guidelines have been developed, both general and specific to HNC 8,9.At the University of Texas MD Anderson Cancer Center (MDACC), our Head and Neck surgical practice has gradually changed as a result of evolving internal and external guidelines (Table 1). Harris County, Texas reported its first COVID-19 case on March 5th, 2020. Since then, the number of cases has been steadily rising with the current incidence at 35 per 100,000 residents in Texas 10. At the institutional level, MDACC has taken many pre-emptive actions and policy changes in response to the growing pandemic (Table 1).The institutional policies described have served to limit hospital attendances in anticipation of a surge in COVID-19 cases in the region. The number of new patients visits to the institution have decreased from 782/week in the first week of March to 207/week in the last week of March (-73.5%) while systemic treatment appointments, indicative of patients already in the process of treatment, have remained fairly stable (3864 to 3288 visits, -14.9%). As a downstream effect, the number of diagnostic imaging visits has decreased from 9616 to 3971 (first and last weeks of March respectively, -58.7%). Surgeries within the institution have shown a more drastic decrease, from 463 to 149 cases per week (-67.8%). Current institutional census at the time of writing (April 7th, 2020) shows 55% general bed occupancy and 35% ICU occupancy. The numbers will continue to change in response to the development of COVID-19 within the region, as we have not yet reached the peak of infection. Predictive models have suggested that the peak in COVID-19 cases will occur at the end of April11 and there are institutional plans on standby to repurpose physical facilities and the workforce to shift focus from oncology care to COVID-19 treatment if needed.In the context of the developing pandemic and tightening institutional guidelines, we seek to understand the early impact of the COVID-19 pandemic on head & neck oncologic surgery practices. We performed a review of outpatient clinic and surgical caseload within the MDACC Head and Neck Surgery department during the pandemic and compared this to the same time period in the preceding year, along with the deviations in management of patients due to COVID-19.

Flora Yan, BA1; Shaun A. Nguyen, MD11: Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina.Word Count: 1,260Conflicts of Interest: None to DiscloseCorresponding Author:Flora YanDepartment of Otolaryngology – Head and Neck Surgery135 Rutledge Avenue, MSC 550, Charleston, SC 29425843-792-8299yanf@musc.eduAbstractSince first identified in December of 2019, COVID-19 has disseminated from Wuhan, China rapidly across the globe. 5-8% of these COVID-19 patients are estimated to become critically ill and will require ICU admission. Predictors of severe/critical ill COVID-19 disease may include increasing age, smoking status, immunosuppression and chronic conditions such as cardiovascular disease, diabetes, hypertension and also cancer. In this brief correspondence, we first describe the outcomes of critically ill patients with and without cancer and extrapolate these findings to the head and neck cancer population.Dear Dr. Hanna,Since first identified in December of 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has disseminated from Wuhan, China rapidly across the globe. On March 11th, 2020 the World Health Organization deemed Coronavirus Disease 2019 (COVID-19) a worldwide pandemic, with the global community in a state of emergency.1 As of April 10th, 2020, 1.6 million COVID-19 cases have been reported worldwide.2 Case-fatality rate have ranged from 2% to 7%.3 Clinically, COVID-19 is initially characterized by a constellation of non-specific symptoms such as cough, fever, and dyspnea. However, this can escalate quickly, with the median time from symptom onset to severe hypoxemia necessitating ICU admission seen to be from 7 to 12 days.4-6 It is clear certain populations such as patients with coexisting conditions, older age, an immunocompromised state and a smoking history are at a high risk for severe disease as well as poor outcomes.7 Head and neck cancer patients are placed in a vulnerable state and may equally be of high-risk to the consequences of COVID-19, given their immunosuppressed state from cancer and corresponding treatment as well as high prevalence of the aforementioned risk factors. In this correspondence, we aim to discuss sequelae of severe COVID-19 disease, in addition to describing head and neck cancer patients as a high-risk population.The majority of COVID-19 cases are of mild severity, however 5-8%5,8 of COVID-19 patients may become critically ill, experiencing respiratory failure, septic shock and/or multi-organ failure. This necessitates admission into the intensive care unit (ICU). Two-thirds of these critically ill patients have met criteria for acute respiratory distress syndrome (ARDS) and require advanced respiratory support. The acute severity and rapid progression of COVID-19 is illustrated with over 63% requiring invasive mechanical ventilation in the first 24 hours of admission.9 Mortality of COVID-19 patients in the ICU has been estimated to be 50%7,10. Of these, patients of older age > 70 years old and with severe comorbidities were seen to have mortality rates of 68 and 59%, respectively.9 As defined by the Center for Disease Control’s weekly morbidity and mortality report regarding COVID-19, these comorbidities may include diabetes mellitus, chronic lung disease, cardiovascular disease, chronic renal disease, and other chronic disease, of which a history of cancer falls under.11ARDS secondary to COVID-19 requires time on mechanical ventilation than is usually required. Bhatraju et al.7 reports a median of 10 days of time on mechanical ventilation before COVID-19 patients were extubated. This is in comparison to 3 to 8 days seen on average for non-COVID related indications for mechanical ventilation.12 Even then, most patients are unable to wean off mechanical ventilation, as seen by a tragically high mortality rate of COVID-19 patients on mechanical ventilation (Table 1) . The Intensive Care National Audit & Research Centre (ICNARC) demonstrated a 67.3% mortality rate of patients receiving advanced (i.e. non-invasive or invasive ventilation, tracheostomy or extracorporeal respiratory support) respiratory support.9 Studies from China examining critically ill COVID-19 patients placed on mechanical ventilation have reported mortality rates of 81% to 97%.4,5 A Seattle-based analysis of critically ill patients on mechanical ventilation saw a comparatively lower mortality rate of 50%, however at the time of this study 3 were still on mechanical ventilation without recovery from COVID-19.7 These extraordinary high mortality rates of patients on mechanical ventilation, ranging from 50% to 97%, may reveal that full intensive care support and life-sustaining therapies still cannot overcome the poor prognosis of certain high-risk populations afflicted by COVID-19. Deterioration despite mechanical ventilation may be confounded by multi-organ system failure. Those who fail mechanical ventilation may be placed on extracorporeal membrane oxygen (ECMO) therapy as end of the line care, however this is often accessible in most hospital systems. In fact, even with substantial cases of critically ill COVID-19 patients, ECMO therapy use has ranged from 6 to 12%.4,5As patients with cancer, especially those in active treatment or in the acute post-treatment phase, are in a particularly immunosuppressed conditions, elucidation of the course of COVID-19 in this patient population is paramount. Liang et al.13 describe a cohort of 18 cancer patients (1 [6%] of which with head and neck cancer) having a higher risk of mechanical ventilation or death (39% vs. 8%), compared to non-cancer patients. Cancer patients also more rapidly deteriorated, with a median time to a critical event taking 13 days as opposed to 43 days in non-cancer patients.Multiple other studies have described cancer patients with COVID-19. Desai et al.14 performed a meta-analysis of 11 studies describing clinical courses of COVID-19 cases and found a 2% prevalence of cancer in patients with COVID-19. Desai et al.14also discovered higher risk of severe events for patients recently treated with chemotherapy or surgery in the past 30 days, over non-cancer COVID-19 patients (75% vs. 43%).Zhang et al.15 revealed clinical characteristics of 28 COVID-19 infected cancer patients in Wuhan China, of which 3 (11%) had head and neck cancer. Of this cohort, 10 (36%) of patients required mechanical ventilation and 8 (29%) patients died. If assumed these 8 were on maximum respiratory therapy previous to death, a mortality rate of 80% can be extrapolated and is in line to mortality rates of critically ill non-cancer patients; this, however, is not explicitly validated in the study. Notably, stage IV disease was associated with higher rates of severe events (ICU admission, mechanical ventilation, or death) than stage I-III disease (70% vs 44%). Zhang et al.15 also revealed patients recently treated with chemotherapy, radiation therapy, and/or immunotherapy in the past 14 days had a 4-times increased odds of developing a severe event than those who received any treatment > 14 days.From this we can observe that 1) prevalence of cancer, active or in remission, in COVID-19 patients is higher than in the general population; 2) COVID-19 patients with cancer may deteriorate more rapidly than non-cancer patients 3) active treatment of cancer may be associated with increased risk of severe COVID-19 sequelae than in patients not undergoing treatment; and 4) critically ill COVID-19 patients who have cancer may more likely develop end-stage respiratory failure or death than non-cancer critically ill patients, barring presence of other chronic illnesses. It is difficult to ascertain how cancer patients in remission may far in comparison to the general population, however it is clear patients undergoing active treatment may present as a high-risk population for severe illness following COVID-19 infection. These observations are limited on data provided by retrospective studies of small sample sizes, and thus must be interpreted with caution.Cancer patients present as a high-risk population for COVID-19 development as well as poorer outcomes. Head and neck cancer patients in particularly may be susceptible to the deleterious effects of not only the viral pathogenesis of COVID-19 itself, but also the long-term psychosocial sequelae of intensive critical care, advanced respiratory treatment and other life-saving measures, all amidst a quarantined environment for a patient population characterized as having twice the suicide risk rate of other cancer patients. Given such high death rates of non-cancer patients on mechanical ventilation, the additive vulnerability from head and neck cancer may make severe or critical ill COVID-19 development quite fatal for our patients. Thus, more attention and perhaps additional testing for patients currently undergoing treatment may be warranted. As described in modified head and neck cancer treatment algorithms16, treatment only for advanced head and neck cancers should proceed with full precautions (i.e. COVID testing, PPE) and any possible methods to reduce nosocomial COVID-19 infection is warranted. We hope this correspondence provides insight in the high-risk of head and neck cancer patients for critical illness following COVID-19 infection.Works Cited1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020. 2020; https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.2. Worldometer. COVID-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/. Accessed April 10th, 2020.3. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy.JAMA. 2020.4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.5. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.6. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet.2020;395(10223):507-513.7. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in Critically Ill Patients in the Seattle Region — Case Series. New England Journal of Medicine. 2020.8. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242.9. ICNARC COVID-19 Study Case Mix Programme Database. ICNARC report on COVID-19 in critica care. 2020; https://www.icnarc.org/About/Latest-News/2020/04/04/Report-On-2249-Patients-Critically-Ill-With-Covid-19.10. Guan W-j, Ni Z-y, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020.11. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020.Morbidity and Mortality Weekly Report. April 3, 2020.12. Seneff MG, Zimmerman JE, Knaus WA, Wagner DP, Draper EA. Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics. Chest. 1996;110(2):469-479.13. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol.2020;21(3):335-337.14. Desai A, Sachdeva S, Parekh T, Desai R. COVID-19 and Cancer: Lessons From a Pooled Meta-Analysis. JCO Global Oncology.2020(6):557-559.15. Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020.16. Day AT, Sher DJ, Lee RC, et al. Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol.2020:104684.

Elderly head and neck cancer patients are at increased risk of adverse outcomes during and after treatment of head and neck cancer. COVID-19 severity and mortality can be expected to be significantly greater in elderly head and neck cancer patients, given that increased age, comorbidities, and presence of malignancy are known risk factors for disease severity and mortality in COVID-19 patients. Therefore, their management requires multidisciplinary consensus and patient input. A thorough geriatric assessment, which has been shown to be beneficial prior to the COVID-19 pandemic, could be particularly helpful in this patient population with the added dimension of COVID-19 risk. In many cases, prudent treatment plan modification may allow for overall best outcomes. Furthermore, recruitment of social services and, when appropriate, palliative care, may allow for optimal management of these patients.

Authors: Arjun Gurmeet Singh MDS (Oral and Maxillofacial Surgery), MFDS (Glasgow) Department of Head and Neck Oncology  Tata Memorial Center and HBNI Mumbai, India (Email: arjun193@gmail.com) Jayita Deodhar,  MD Department of Palliative Medicine Tata Memorial Center and HBNI Mumbai, India (Email: jukd2000@yahoo.co.uk) Pankaj Chaturvedi, MS, FACS, (Corresponding Author) Department of Head and Neck OncologyTata Memorial Center, Mumbai, India (Email: chaturvedi.pankaj@gmail.com)

Aim: The COVID pandemic is caused by infection with the SARS-CoV-2 virus. The major mutation detected to date in the SARS-CoV-2 viral envelope spike protein, which is responsible for virus attachment to the host and is also the main target for host antibodies, is a mutation of an aspartate (D) at position 614 found frequently in Chinese strains to a glycine (G). We sought to infer health impact of this mutation. Result: Increased case fatality rate correlated strongly with the proportion of viruses bearing G614 on a country by country basis. The amino acid at position 614 occurs at an internal protein interface of the viral spike, and the presence of G at this position was calculated to destabilize a specific conformation of the viral spike, within which the key host receptor binding site is more accessible. Conclusion: These results imply that G614 is a more pathogenic strain of SARS-CoV-2, which may influence vaccine design. The prevalence of this form of the virus should also be included in epidemiologic models predicting the COVID-19 health burden and fatality over time in specific regions. Physicians should be aware of this characteristic of the virus to anticipate the clinical course of infection. What is known about this topic? Nothing is known about the health significance of the D614G SARS-CoV-2 variant. What does this article add? A molecular clue to viral molecular pathogenesis of COVID-19 disease.

The outbreak of the 2019-nCoV virus has coincided with Chinese Lunar New Year, when tens of millions of people travel for the Spring Festival holiday during the world's largest annual human migration. Travellers give wings to novel coronavirus. Thanks to China's efforts that they have effectively contained the cross-border spread of the 2019-nCoV.Medicine staff make great effort to prevent and control the epidemic disease, and so do community service workers. AS of Sunday, 53 community workers had died in the line of duty in China's prevention and control of the 2019-nCoV epidemic, according to the Ministry of Civil Affairs . In the fight against 2019-nCoV, community workers have been facing enormous pressure, including a high risk of infection and inadequate protection from contamination, overwork, frustration, patients with negative emotions, a lack of contact with their families, and exhaustion. Thanks to community workers, the virus transmission route is cut off and the emergence of new cases is effectively curbed.

Objectives The prevention and control of the COVID-19 pandemic might associate with paternal perinatal depression during their partners’ delivery. This study aims to investigate the prevalence of paternal perinatal depression exposure to the COVID-19 pandemic and to determine the risk factors. Design This is a cross-sectional study Population The participants of perinatal fathers were recruited in one hospital during December 31, 2019 to April 11, 2020 in Wuhan. Methods The Edinburgh Postnatal Depression Scale (EPDS) and the APGAR family function scale was used to evaluate paternal perinatal depression and family function, respectively. The chi-square tests and multivariable logistic regression were applied for data analysis. Results There were 1,187 valid fathers included and the prevalence of paternal perinatal depression was 13.82%. Compared with fathers recruited before the announcement of human-to-human transmission, fathers showed significantly lower risk of perinatal depression (OR=0.54, 95% CI: 0.34, 0.87; OR=0.30, 95% CI: 0.14, 0.63; respectively) during traffic restriction period and public transportation reopened period in Wuhan. Low or fair of family function significantly associated with elevated risk of paternal perinatal depression (OR=2.45, 95% CI: 1.56, 3.83). Moreover, fathers reported low family income, poor sleep quality, and smoking were significantly associated with increased risks of perinatal depression. Conclusions Paternal screening was suggested to early detect perinatal depression during the COVID-19 pandemic. Traffic restriction and good family function have positive impacts on paternal perinatal depression. These results could provide some evidence for health authorities to formulate targeted prevention and control strategies on paternal perinatal depression.

Objective To analyze the factors of BPPV patients increased significantly in our hospital. Methods From February 5, 2020 to March 7, 2020, 29 patients were diagnosed as BPPV with detailed physical examination records. Age, sex, risk factors of cerebrovascular diseases, exercise, time spent asleep or in bed, and time spent outside during sunny periods were analyzed. A total of 26 BPPV patients were reviewed during the period of February 9, 2019 to April 30, 2019, and the above information was recorded through a telephone survey. Using Stata 15.1 statistical software, the measurement data in accordance with normal distribution are expressed by \(\overline{x}\pm S\), and the comparison between groups is expressed by t test; the counting data is expressed by frequency or percentage, and the comparison between groups is performed by Fisher exact test. Results Analysis between male and female found a difference that females were still the main group of BPPV; there were significant differences in exercise time, time spent in bed and time spent in the sun between the two groups (P < 0.001). Conclusion The BPPV of young and middle-aged people increased significantly during a period 30 days under the quarantine policy in Hangzhou. Age, risk factors of cerebrovascular diseases is not the main risk factor of BPPV. Lack of exercise and the prolonged time spent lying are the important risk factors. Changing unhealthy lifestyles may be the solution to decreasing the morbidity of BPPV. Significance Finding the possible mechanism for BPPV, put forward new hypothesis.

Discussion Coronavirus disease 2019 (COVID-19) is highly transmittable pathogenic viral infection caused by a novel coronavirus (2019-nCoV) closely related to the Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS) Coronaviruses. was first identified in Wuhan, Hubei province, China on December 8, 2019. and has rapidly spread around the world causing a global health crisis.The signs & symptoms of SARS-CoV-2 induced COVID-19 are a bit similar to those seen in other respiratory infections and include the following finding at onset of illness [1, 2 ,3] fever (83 % -98.6 %), Dry cough (59.4-82) & fatigue, myalgia “(muscle pain) (69.6 % -44 %) with less common symptoms headache (8%), sore throat (5%) & diarrhea (3%)Until presently there are no safe promising clinical treatments, no vaccine or documented anti COVID 19 drugs are validated to develop efficient therapeutic strategies except for Remdesivir, in addition favipiravir & combination therapy with hydroxychloroquine plus azithromycin which all been evaluated against COVID-19 in clinical trials, resulted in clinical recovery [4]The World Health Organization had declared the outbreak to be Public Health emergency of international concern on 30 January 2020 and as the cases spread from Wuhan, throughout China and into other countries. The first case of 2019-20 corona virus was confirmed to have reached Bahrain in February 21st 2020, substantially followed by Saudi Arabia in March 2nd 2020, soon after on march 11 2020 as the cases surged the world health Organization (WHO) recognized it as pandemicAs COVID-19 began to spread and according to the current evidence [5] the primary method of transmission between people is thought to occur through respiratory droplets and contact routes. In order to protect the health care workers and non-infected patients from potential COVID-19 patients, infection control measures were established in most of institutes especially the ENT departments to minimize the nosocomial spread among the health workerThe strategy for infection control against COVID-19 includes material preparation and distribution upon the availability, triage strategy, training on infection prevention measures, limiting the traffic to the hospital inpatient and outpatient, preparedness for hospital disaster plan and specific disaster plan for each department, emergency expansion plan for the intensive care unit capacity, Preparedness for field medical words and Intensive care unit, etc.5 days after WHO announced the CoVid 19 pandemic We followed the new policy guidelines by avoiding the grouping so decisions were made regarding departmental meeting including the training activities and journal club to withhold it and transferred into a virtual meeting and internal memo which is distributed through emails till recentlyTo reduce the number of patients’ visits in our clinics, in a manner without compromising the patientcare we started using phone call consultation method (figure 1). We offered to refill medication for stable patient’s and sending medications using the hospital pharmacy transport service (figure 2)We confined the appointments for the emergency and the post-operative cases, we Minimize the elderly patients and the patients with comorbidities traffic into the hospital and we restricted the walk-in patients for the clinics for all the consultants.As well as we follow the policy of separating or distancing the appointment time for the patient presented to the departmentWe also limited access to the clinics by arranging the following: we started sending List of Outpatients appointments information at least one day in advanced to the Security Gates for allowing only the scheduled patients to enter, then the patient had to pass by two visual triage units one at the hospital entrances and other at the clinic entrance following the score criteria for the COVID-19After being screened by the triage station the patients were requested to get seated in the Waiting area and the seats arrangements were distant for the safety precautions (figure 3)In the clinical room, nose and throat examinations were considered to present the highest risk, and additional protective measures were implemented from our side., so all patients have been requested to sit on the non-clinical chair and in case of the condition required clinical examination then they are requested to get seated on the clinical examination chairOn the Ent clinical examination, the threshold for the endoscopic examination of the nose and pharynx have been reduced to the maximum and the personal protective equipment use has been implicated as the rules and hospital guidelines and in case of endoscopic examination needed a local anesthetic spray was replaced by gel anesthesia, and the smallest possible diameter laryngoscope was recommended to reduce sneezing and cough reflexesHence the endoscopic procedures are considered an aerosol generating so all surfaces in the clinic room can potentially become contaminated thus we performed an appropriate disinfection between each patients & post the endoscopy proceduresOur department has decided to reschedule and postpone all elective procedures that may aerosolize tissue including tonsillectomy, adenoidectomy Sino-nasal surgery, and other airway procedures. While we agreed that’s the otological procedures along with the oncology procedure where continued until further notice for phase 1 emergency response to an outbreakWhen a procedure is indicated, appropriate personal protective equipment must be worn including fluid-resistant gown, gloves, eye protection, full face shield, fit-tested N95 respirator, head cover, and impermeable shoes that can be disinfected (figure 4)Inside the operating room we Limited the number of healthcare providers participating in any procedure to only those absolutely necessary.After surgery we try to minimize the hospital stay postoperatively and trying to discharge the patient same day of the surgeryWith fewer cases and clinics, we have begun assigning our staff to attend a comprehensive training and Operational courses to support country preparedness and response to this pandemic as well we encourage them to be involved in research related activities & creating a database for departmental and/or multidisciplinary

China has developed convalescent plasma to treat patients who are infected with COVID-19 patients and treatment effect is positive. There are some experiences worthy of our share in convalescent plasma collection and infusion. We successfully applied of the technique to therapy a COVID-19 patient in Hubei province, China.

SARS-CoV-2 has been shown to bind the host cell ACE2 receptor through its spike protein receptor binding domain (RBD), required for its entry into the host cells. We have screened phytocompounds from a medicinal herb, Tinospora cordifolia, for their capacities to interrupt the viral RBD and host ACE2 interactions. We employed molecular docking to screen phytocompounds in T. cordifolia against the ACE2-RBD complex, performed molecular dynamics (MD) simulation, and estimated the electrostatic component of binding free energy. ‘Tinocordiside’ docked very well at the center of the interface of AEC2-RBD complex, and was found to be well stabilized during MD simulation. Tinocordiside incorporation significantly decreased electrostatic component of binding free energies of ACE2-RBD complex (23.5 and 17.10 kcal/mol in the trajectories without or with the ligand, respectively). It indicates that such an interruption of electrostatic interactions between the RBD and ACE2 would weaken or block COVID-19 entry and its subsequent infectivity. We postulate that natural phytochemicals like Tinocordiside could be the viable options for controlling COVID-19 contagion and its entry into host cells.